直肠癌保肛术后低位前切除综合征发生率、恢复情况及影响因素的回顾性分析

蒲羽; 邱远; 李祥; 王文生; 杨桦; 肖卫东

doi:10.16016/j.1000-5404.201611130

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直肠癌保肛术后低位前切除综合征发生率、恢复情况及影响因素的回顾性分析

临床医学 | 更新时间：2026-02-09

- 直肠癌保肛术后低位前切除综合征发生率、恢复情况及影响因素的回顾性分析
- Incidence, risk factor and recovery of low anterior resection syndrome following sphincter-preserving surgery for rectal cancer: a retrospective analysis of 337 cases
- 第三军医大学学报 2017年39卷第10期页码：1025-1030
- 作者机构：
  
  400037 重庆，第三军医大学新桥医院普通外科
- 作者简介：
  
  [肖卫东, 电话：(023)68763180, E-mail：weidong.xiao@126.comXiao Weidong, Tel:86-23-68763180, E-mail:weidong.xiao@126.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201611130
  中图分类号： R619;R730.56;R735.37
- 收稿：2016-11-15，
  
  修回：2017-01-01，
  
  纸质出版：2017-05-30
- 稿件说明：
移动端阅览
蒲羽, 邱远, 李祥, 等. 直肠癌保肛术后低位前切除综合征发生率、恢复情况及影响因素的回顾性分析[J]. 第三军医大学学报, 2017,39(10):1025-1030.

Yu Pu, Yuan Qiu, Xiang Li, et al. Incidence, risk factor and recovery of low anterior resection syndrome following sphincter-preserving surgery for rectal cancer: a retrospective analysis of 337 cases[J]. Journal of Third Military Medical University, 2017, 39(10): 1025-1030.
蒲羽, 邱远, 李祥, 等. 直肠癌保肛术后低位前切除综合征发生率、恢复情况及影响因素的回顾性分析[J]. 第三军医大学学报, 2017,39(10):1025-1030. DOI： 10.16016/j.1000-5404.201611130.

Yu Pu, Yuan Qiu, Xiang Li, et al. Incidence, risk factor and recovery of low anterior resection syndrome following sphincter-preserving surgery for rectal cancer: a retrospective analysis of 337 cases[J]. Journal of Third Military Medical University, 2017, 39(10): 1025-1030. DOI： 10.16016/j.1000-5404.201611130.

摘要

目的

探讨直肠癌患者保肛术后低位前切除综合征(low anterior resection syndrome，LARS)的发生率、恢复情况及影响因素。

方法

回顾性分析2012年5月至2015年1月第三军医大学新桥医院普通外科确诊为直肠癌并行保肛根治术的患者337例，其中男性208例，女性129例，年龄(61.03±11.32) 岁。收集患者临床、病理及随访资料，选择可能对直肠癌保肛术后LARS发生产生影响的临床病理因素进行单因素及多因素Logistic回归分析，并分析术后恢复时间及骨盆径线对LARS的影响。

结果

337例直肠癌患者LARS评分均数为14.08(0~41)，126例(37.4%)有LARS症状，其中重度LARS占总例数的18.7%。多因素Logistic回归分析显示：吻合口位置越低、术前放疗、术后恢复时间越短均是患者术后存在LARS的独立危险因素(

＞1，

0.05)。术后不同时间段的直肠癌患者LARS评分比较显示：与术后6个月内比较，术后6~18个月LARS评分呈逐步且显著下降的趋势(

0.01)。对于手术18个月后的患者研究显示：吻合口距肛缘＜5 cm直肠癌患者LARS发生率显著高于吻合口距肛缘≥5 cm组(

0.05)；骨盆径线资料对比分析发现，吻合口距肛缘＜5 cm直肠癌患者中，LARS组坐骨棘间径显著小于无LARS组(

0.05)。

结论

LARS是直肠癌特别是低位直肠癌保肛术后的常见并发症，吻合口位置、术前放疗及术后恢复时间均为影响LARS发生发展的重要因素；直肠癌患者术后LARS症状出现显著改善至少需6个月以上；骨盆横径特别是坐骨棘间径大小可预测低位直肠癌术后LARS发生及恢复情况。

Abstract

Objective

To evaluate the incidence

prognosis and risk factors of low anterior resection syndrome (LARS) in Chinese patients undergoing sphincter-preserving surgery for rectal cancer.

Methods

A total of 337 patients with rectal cancer (including 208 male and 129 female patients with a mean age of 61.03±11.32 years) undergoing total mesorectal excision and colorectal anastomosis between May 2012 and January 2015 were asked to complete a verified version of the Low Anterior Resection Score questionnaire. The clinical and pathological factors that may influence the occurrence of LARS were analyzed using univariate and multivariate logistic regression analysis. The influence of postoperative recovery time and pelvic size on the occurrence of LARS was analyzed.

Results

The mean LARS score of the patients was 14.08 (range 0~41). A total of 126 patients (37.4%) developed LARS after the surgery

including 63 (18.7%) severe cases. Multivariate logistic regression analysis identified lower locations of anastomosis

pre-surgery radiotherapy

and shorter postoperative recovery time as independent risk factors of LARS (

0.05). Compared with the scores within the initial 6 postoperative months

the LARS scores of the patients in 6~18 months after the surgery showed significant and progressive reductions (

0.01). At 18 months after the surgery

the patients with low rectal cancer (anastomotic site

5 cm from the anal verge) had a significantly higher incidence of LARS (

0.05)

and those who developed LA

RS were found to have a significantly shorter interspinous distance than those without LARS (

0.05).

Conclusion

LARS is a common complication after sphincter-preserving surgery for rectal cancer

especially in patients with a low anastomotic site. Lower locations of anastomosis

pre-operative radiotherapy

and shorter postoperative recovery time are independent risk factors of LARS occurrence. LARS symptoms can be significantly improved after at least 6 months after the surgery. The interspinous distance may serve as a potential predisposing factor that affects LARS occurrence and recovery in patients with low rectal cancer.

关键词

Keywords

references

Tilney H S, Heriot A G, Purkayastha S, et al.A national perspective on the decline of abdominoperineal resection for rectal cancer[J]. Ann Surg, 2008, 247(1): 77-84. DOI: 10.1097/SLA.0b013e31816076c3.

Pachler J, Wille-Jorgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy[J]. Cochrane Database Syst Rev, 2012, 12: CD004323. DOI: 10.1002/14651858.CD004323.pub4.

Bregendahl S, Emmertsen K J, Lous J, et al.Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer:a population-based cross-sectional study[J]. Colorectal Dis, 2013, 15(9): 1130-1139. DOI: 10.1111/codi.12244.

Bryant C L, Lunniss P J, Knowles C H, et al.Anterior resection syndrome[J]. Lancet Oncol, 2012, 13(9): e403-e408. DOI: 10.1016/S1470-2045(12)70236-X.

Emmertsen K J, Laurberg S. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer[J]. Br J Surg, 2013, 100(10): 1377-1387. DOI:10.1002/bjs.9223.

Chen T Y, Wiltink L M, Nout R A, et al. Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial[J]. Clin Colorectal Cancer, 2015, 14(2): 106-114. DOI: 10.1016/j.clcc.2014.12.007.

Ekkarat P, Boonpipattanapong T, Tantiphlachiva K, et al. Factors determining low anterior resection syndrome after rectal cancer resection:A study in Thai patients[J]. Asian J Surg, 2016, 39(4): 225-231. DOI: 10.1016/j.asjsur.2015.07.003.

Emmertsen K J, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer[J]. Ann Surg, 2012, 255(5): 922-928. DOI: 10.1097/SLA.0b013e31824f1c21.

Hou X T, Pang D, Lu Q, et al.Validation of the Chinese version of the low anterior resection syndrome score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients[J]. Eur J Oncol Nurs, 2015, 19(5): 495-501. DOI: 10.1016/j.ejon.2015.02.009.

Juul T, Ahlberg M, Biondo S, et al.Low anterior resection syndrome and quality of life:an international multicenter study[J]. Dis Colon Rectum, 2014, 57(5): 585-591. DOI: 10.1097/DCR.0000000000000116.

Scheer A S, Boushey R P, Liang S, et al.The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer: a systematic review and meta-analysis[J]. Dis Colon Rectum, 2011, 54(12): 1589-1597. DOI: 10.1097/DCR.0b013e3182214f11.

Pucciani F. A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome[J]. Updates Surg, 2013, 65(4): 257-263. DOI: 10.1007/s13304-013-0220-5.

Ziv Y, Zbar A, Bar-Shavit Y, et al. Low anterior resection syndrome(LARS): cause and effect and reconstructive considerations[J]. Tech Coloproctol, 2013, 17(2): 151-162. DOI: 10.1007/s10151-012-0909-3.

Saito N, Ito M, Kobayashi A, et al. Sphincter-saving resection for low rectal cancer[J]. Nihon Geka Gakkai Zasshi, 2011, 112(5): 318-324.

Martin S T, Heneghan H M, Winter D C. Systematic review of outcomes after intersphincteric resection for low rectal cancer[J]. Br J Surg, 2012, 99(5): 603-612. DOI: 10.1002/bjs.8677.

Battersby N J, Juul T, Christensen P, et al.Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer:A Multicenter Cross-Sectional Study[J]. Dis Colon Rectum, 2016, 59(4): 270-280. DOI: 10.1097/DCR.0000000000000552.

van Gijn W, Marijnen C A, Nagtegaal I D, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer:12-year follow-up of the multicentre, randomised controlled TME trial[J]. Lancet Oncol, 2011, 12(6): 575-582. DOI: 10.1016/S1470-2045(11)70097-3.

胡克, 李文博, 侯晓荣, 等.局部进展期直肠癌术前新辅助治疗疗效分析[J].中华放射肿瘤学杂志, 2011, 20(6): 502-505. DOI: 10.3760/cma.j.issn.1004-4221.2011.06.016.

Hu K, Li W B, Hou X R, et al. The efficacy of neoadjuvant concurrent chemoradiotherapy or radiotherapy alone in patients with locally advanced rectal cancer[J]. Chin J Radiat Oncol, 2011, 20(6): 502-505. DOI: 10.3760/cma.j.issn.1004-4221.2011.06.016.

Pach R, Kulig J, Richter P, et al. Randomized clinical trial on preoperative radiotherapy 25 Gy in rectal cancer--treatment results at 5-year follow-up[J]. Langenbecks Arch Surg, 2012, 397(5): 801-807. DOI: 10.1007/s00423-011-0890-8.

Bregendahl S, Emmertsen K J, Fassov J, et al.Neorectal hyposensitivity after neoadjuvant therapy for rectal cancer[J].Radiother Oncol, 2013, 108(2): 331-336. DOI: 10.1016/j.radonc.2013.07.004.

Romaniszyn M, Richter P, Walega P, et al. Low-anterior-resection syndrome. How does neoadjuvant radiotherapy and low resection of the rectum influence the function of anal sphincters in patients with rectal cancer Preliminary results of a functional assessment study[J]. PolPrzegl Chir, 2012, 84(4): 177-183. DOI: 10.2478/v10035-012-0029-9.

Kakodkar R, Gupta S, Nundy S. Low anterior resection with total mesorectal excision for rectal cancer: functional assessment and factors affecting outcome[J]. Colorectal Dis, 2006, 8(8): 650-656. DOI: 10.1111/j.1463-1318.2006.00992.x.

Boy1e K M, Petty D, Cha1mers A G, et al.MRI assessment of the bony pelvis may help predict resectability of rectal cancer[J]. Colorectal Dis, 2005, 7(3): 232-240. DOI: 10.1111/j.1463-1318.2005.00819.x.

Akiyoshi T, Watanabe T, Ueno M. Pelvic dimensions as a predictor of difficulty in laparoscopic surgery for rectal cancer[J]. Surg Endosc, 2011, 25(9): 3122-3123. DOI: 10.1007/s00464-011-1649-6.

Wang C, Xiao Y, Qiu H, et al. Factors affecting operating time in laparoscopic anterior resection of rectal cancer[J]. World J Surg Oncol, 2014, 12: 44. DOI: 10.1186/1477-7819-12-44.

Ogiso S, Yamaguchi T, Hata H, et al. Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer:"narrow pelvis" is not a contraindication[J]. Surg Endosc, 2011, 25(6): 1907-1912. DOI: 10.1007/s00464-010-1485-0.

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